- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $38.90 / $229.09 / $549.54
| Facility | | $38.90 | $229.09 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.32 / $28.84 / $83.18
| Facility | 26 | $8.32 | $28.84 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $33.11 / $61.66 / $263.03
| Facility | TC | $33.11 | $61.66 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $8.51 / $41.69 / $120.23
| Professional | | $8.51 | $41.69 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.08 / $13.80 / $50.12
| Professional | 26 | $7.08 | $13.80 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $18.20 / $85.11 / $194.98
| Professional | 50 | $18.20 | $85.11 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- 52
- Typical Low / Median / Typical High
- $20.42 / $29.51 / $208.93
| Professional | 52 | $20.42 | $29.51 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.89 / $38.02 / $87.10
| Professional | TC | $20.89 | $38.02 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $20.89 / $26.30 / $38.02
| Professional | | $20.89 | $26.30 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $5.01 / $6.31 / $11.48
| Professional | 26 | $5.01 | $6.31 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $30.20 / $41.69 / $48.98
| Professional | 50 | $30.20 | $41.69 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $15.85 / $20.42 / $33.11
| Professional | TC | $15.85 | $20.42 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $19.95 / $75.86 / $131.83
| Facility | | $19.95 | $75.86 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $29.51 / $35.48 / $144.54
| Professional | | $29.51 | $35.48 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.31 / $7.94 / $17.38
| Professional | 26 | $6.31 | $7.94 | $17.38 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $23.44 / $27.54 / $112.20
| Professional | TC | $23.44 | $27.54 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $114.82 / $269.15
| Facility | | $67.61 | $114.82 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $1.95 / $9.12 / $13.18
| Facility | 26 | $1.95 | $9.12 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $6.03 / $28.18 / $40.74
| Facility | TC | $6.03 | $28.18 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $26.30 / $36.31 / $69.18
| Professional | | $26.30 | $36.31 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $6.76 / $9.55 / $17.78
| Professional | 26 | $6.76 | $9.55 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $19.50 / $25.70 / $52.48
| Professional | TC | $19.50 | $25.70 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $38.90 / $194.98
| Facility | | $28.84 | $38.90 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $19.05 / $100.00 / $100.00
| Facility | 26 | $19.05 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- TC
- Typical Low / Median / Typical High
- $54.95 / $117.49 / $117.49
| Facility | TC | $54.95 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $34.67 / $223.87
| Professional | | $28.84 | $34.67 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $8.13 / $10.00 / $70.79
| Professional | 26 | $8.13 | $10.00 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $25.70 / $169.82
| Professional | TC | $20.42 | $25.70 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $14.45 / $74.13 / $95.50
| Facility | | $14.45 | $74.13 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $28.84 / $33.11 / $87.10
| Professional | | $28.84 | $33.11 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $7.94 / $8.91 / $40.74
| Professional | 26 | $7.94 | $8.91 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $70.79 / $70.79 / $77.62
| Professional | 50 | $70.79 | $70.79 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- TC
- Typical Low / Median / Typical High
- $20.42 / $24.55 / $85.11
| Professional | TC | $20.42 | $24.55 | $85.11 |